For some time, optimized perioperative pathway protocols have been implemented in orthopedic surgery. In our hospital an accelerated clinical pathway has been successfully in effect for several years, focused on safely decreasing patients' length of stay and increasing their function at the time of discharge. The aim of the present project was to evaluate whether a further optimization is even more promising regarding early postoperative outcome parameters. Prospective, parallel group design in an Orthopaedic University Medical Centre. 143 patients, scheduled for unilateral primary total knee replacement (TKR) under perioperative regional analgesia were included. 76 patients received a Standard Accelerated Clinical Pathway (SACP). 67 patients received an Optimized Accelerated Clinical Pathway (OACP) including patient-controlled regional analgesia pumps, ultra-early/doubled physiotherapy and motor driven continuous passive motion machine units. Main measures were early postoperative pain on a visual analogue scale, consumption of regional anaesthetics, knee range of motion, time out of bed, walking distance/stair climbing, circumference measurements and Knee Society Scores of the operated leg. Patients in both groups were checked for a possible discharge by a blinded orthopedic surgeon on the 5th and 8th postoperative (po) day, using a discharge checklist including the KATZ Index of Independence in Activities of Daily Living, standard requirements for pain at rest/mobilization, walking distance and regular wound healing. A potential discharge was only approved if the patient was able to meet all six criteria from the discharge checklist. Re-admission within 6 weeks after discharge from hospital was registered.Background
Materials and Methods
